• Manu Thakral, Rod L Walker, Kathleen Saunders, Susan M Shortreed, Michael Parchman, Ryan N Hansen, Evette Ludman, Karen J Sherman, Sascha Dublin, and Von KorffMichaelMKaiser Permanente Washington Health Research Institute, Seattle, Washington..
• Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, Washington. Electronic address: thakral.m@ghc.org.
• J Pain. 2018 Jan 1; 19 (1): 111-120.

AbstractDose reduction and risk mitigation initiatives have been recommended to reduce opioid-related risks among patients receiving chronic opioid therapy (COT), but questions remain over whether these initiatives worsen pain control and quality of life. In 2014 to 2015, we interviewed 1,588 adult COT patients within a health care system in Washington State and compared those who received dose reduction and risk mitigation initiatives in primary care clinics (intervention) with patients in comparable health care settings without initiatives (control). The primary outcomes were pain assessed using the pain, enjoyment, and general activity (PEG) scale, a 3-item scale to assess global pain intensity and interference, with secondary measures including depression (Patient Health Questionnaire-8 scale). Generalized estimating equations for linear regression models were used to estimate differences in mean scores between intervention and control sites. Estimated differences, adjusted for patient characteristics and weighted for nonresponse, between patients at intervention and control clinics were not clinically significant for the PEG (-.03, 95% confidence interval = -.25 to .19) or Patient Health Questionnaire-8 (-.64, 95% confidence interval = -1.19 to -.08). We found no evidence that COT patients in clinics with dose reduction and risk mitigation initiatives had clinically meaningful differences in pain intensity, interference with activities and enjoyment of life, or depressive symptoms compared with control health care settings.Copyright © 2017 The American Pain Society. Published by Elsevier Inc. All rights reserved.

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